Radiation-induced hyposalivation and its treatment with oral pilocarpine.

OBJECTIVE: The aim of this study was to determine the effects of radiation on the secretion of saliva from mucous salivary glands in comparison with serous salivary glands. STUDY DESIGN: The minor salivary glands of the palate were used as an example of mucous glands, while the parotid glands were used as an example of a serous secretion organ. Serial flow rate measurements of the parotid and palatal glands were taken over a period of approximately 9 months in 13 patients who suffered from malignancies of the head and neck region. Twelve patients consented to take part in a second study in which salivary flow was stimulated by oral pilocarpine before and at the conclusion of radiotherapy and 7 months later. Complaints and symptoms were recorded at each time of measurement. RESULTS: After radiotherapy, the secretory performance of the parotid glands dropped off rapidly and irreversibly. Salivary secretion from the palatal glands was not totally diminished as a result of radiation. Clinical complaints and histologic findings indicate a serious alteration of the tissues irradiated; however, residual secretion from the remaining parenchyma of the mucous glands still remains. Pilocarpine produced a clinically significant increase of salivary flow from the palatal glands before and 7 months after radiation. Secretory performance of the parotid glands could not be sufficiently increased by stimulation with pilocarpine after radiotherapy. Clinical side effects and risks for the treatment of symptomatic postradiation xerostomia with pilocarpine were minimal. CONCLUSIONS: These findings emphasize the greater resistance and recoverability of the mucous secreting minor palatal glands in comparison with the serous secreting parotid glands. They also indicate the significant postradiation ability of the mucous secreting glands to be stimulated by pilocarpine.

Spectrophotometric analysis of all-ceramic materials and their interaction with luting agents and different backgrounds.

In this study, two All-Ceramic (AC) materials--Empress 2 (EMP) (Ivoclar Vivadent AG, Schaan, Liechtenstein) and In-Ceram ALUMINA (ICA) (Vita Zahnfabrik, Bad Säckingen, Germany)--were analyzed, along with the effects of 3 luting agents-viz. Zinc Phosphate cement (ZNPO, PhospaCEM PL, Ivoclar Vivadent AG, Schaan, Liechtenstein), Glass Ionomer Cement (GIC, Ketac-Cem Radiopaque, ESPE Dental AG, Seefeld, Germany), and Compolute (COMP, ESPE Dental AG, Seefeld, Germany)--on the final color, using the CIELab system. Color differences (DeltaL, Deltaa, Deltab, and DeltaE) were calculated for samples with luting agents and for samples without luting agents with standard white and black backgrounds, with the use of a spectrophotometer, Luci 100 (Dr. Lange, Berlin, Germany). One-way ANOVA for DeltaL, Deltaa, Deltab, and DeltaE within both the AC systems, with and without luting agents, showed significant contributions of the background (p < 0.05). EMP was seen to be more translucent than ICA. Darker ceramics showed less color variation. Luting agents altered the final color of the restoration. ZNPO was least translucent, followed by GIC and COMP. Marginal increases in thicknesses of ICA samples (0.4 mm) do not show a statistically significant color difference. No method exists to predict the outcome of an AC restoration based on consideration of the luting agent and the background color.

[3-dimensional supporting pivot for the determination of a painless mandibular position]. / Dreidimensional verstellbarer Stützstift zur Ermittlung einer beschwerdefreien Unterkieferposition.

A three dimensional adjustable supporting system is described which is useful in achieving a trouble-free mandibular position in asymmetrical myoarthropathies. The reproducible adjustment of the supporting point makes it possible to compare different favourable positions of the condyle with least expenditure of technique and time. The description is supplemented by a case report.

[Lateral radiography of the temporomandibular joint with a new radiological device]. / Laterale Kiefergelenk-Röntgenaufnahmen mit einer neuen apparativen Anordnung.

A lateral eccentric visualization of the temporo-mandibular joint is described using a new radiological arrangement. The exposures are made with the patient sitting and project the lateral aspect of the joint on to the picture plane, giving a symmetrical picture of the condyle, fossa mandibularis, tuberculum articulare and joint space. The exposure technique distinguishes itself by its simplicity and can be used in combination with every dental X-ray machine.

[Reactions of the oral mucosa to mechanical load stimuli from dentures]. / Reaktionen der Mundschleimhaut auf Belastungsreize der Prothese.

The oral mucosa is the primary medium bearing removable dentures. Problems of adaptation and incompatibility of denture bases borne by mucosal tissues first of all arise at the mucosa covering the palate and the alveolar ridges. Depending on its functional qualities, the denture bearing mucosa more or less fulfills the task of buffering chewing forces acting on the denture base and distributing them on the bone surface. Studies on physiological and morphological reactions of the denture bearing tissues resulting from mechanical stresses show that the mucosa is entirely capable of tolerating short-term pressures during chewing. In this connection the increase in the thickness of the denture bearing mucosa must be considered as a physiological response to mechanical load.

[Physiology and pathophysiology of the minor salivary glands]. / Physiologie und Pathophysiologie der kleinen Speicheldrüsen.

Measurements of the secretory rates of the palatine and the parotid glands, assessing the electrolyte content of all salivary fractions and combined clinical biotic studies underline the clinical importance of the minor salivary glands. The minor salivary glands are shown to be organs whose function is decisively involved in symptoms such as xerostomia, stomatodynia, and what is known as "denture intolerance". Moreover, proper secretion of the palatine glands is of crucial importance for the physical retention of maxillary full dentures. There are no connections between secretory rates of major and minor salivary glands. The effect of certain drugs on salivary production and thus on the symptoms of hyposalivation seems to be considerable. Treatment methods for inadequate salivary secretion are outlined. The adaptive tendency of properly functioning palatine glands appears to be high. The fact that atrophic and dystrophic processes can be functionally compensated to a relatively high degree speaks for the dynamic capability of the glandular parenchyma. In view of the clinical relevance of the minor salivary glands it is mandatory that the functional principles and control mechanisms underlying their secretion be investigated in future studies.

Parameters of tooth mobility in cases of normal function and functional disorders of the masticatory system.

Tooth mobility was measured mechano-electronically with the aid of quasi-static and dynamic methods in 309 patients comprising 2650 teeth being periodontally healthy. Besides, clinical and roentgenographic findings were ascertained to relate functional features to each periodontium. In general the result was that teeth loaded excessively show increased mobility parameters compared to those loaded normally. However, the mobility of teeth loaded poorly or deficiently was even greater compared to teeth stressed excessively. Moreover, follow-up studies showed that tooth mobility decreases after removal of functional disorders of the masticatory system or an immobilisation of splinted teeth. An experimental trauma of the periodontal ligament also brings on an increased tooth mobility which decreases to the original values some days after the trial.

[The fitting behavior of rigid free-end prostheses]. / Zum Einlagerungsverhalten starr abgestützter Freiendprothesen.

In five cases, the embedment of balanced free-end prostheses was monitored quantitatively for a period of several weeks. It could be shown that embedment is time dependent and appears to be concluded only after a period of three weeks. The measured values ranged from 0.2 and 0.3 mm. In most cases, however, the primary embedment occurs within the first four or five days.

[The effect of the arrangement of the artificial sets of teeth on the physical stability of total protheses]. / Die Beeinflussung der physikalischen Grundhaftung von Totalprothesen durch die Anordnung der künstlichen Zahnreihen.

The effect of masticatory forces within and outside the stable stress-bearing areas of the complete upper denture on the pressure gradient and the flow of saliva into the space under the prosthesis were demonstrated with standardized tests. It was shown that masticatory stress within the stable area led to a continual increase in pressure in the space under the prosthesis. Masticatory force outside the stable area led to a decrease in pressure and an equalization of pressure in this space as well as dislocation and tilting of the complete denture. Due to masticatory force outside the stable area, the shape of the ridge influences the stability of the complete denture.

[The necessity of registration measurements in the construction of masticatory surfaces]. / Uber die Notwendigkeit von Registriermassnahmen beim Aufbau von Kauflächen.

Model studies of denture forms with group contact and front canine guidance showed that a procedure for the reconstruction of grinding surfaces not directly involved in movement guidance, based on the mean values, can be accurate. The standard measures of registration for transference to a semiadjustable articulator are adequate for satisfactorily reducing vertical deviations to a clinically tolerable minimum in reconstruction guide planes.

[Biometric studies on implanted and natural abutments]. / Biometrische Untersuchungen an implantierten und natürlichen Prothesenpfeilern.

The mobility of 50 osseointegrated implants, inserted for improvement of the support of dentures in edentulous lower jaws, was studied during a period of up to 3 years by means of mechano-electronic measurements. The results showed that 3 months after implantation osseointegrated implants have less quasi-static mobility than natural teeth without periodontal lesions. Under the stresses of mastication the mobility of osseointegrated implants continuously increases. After 2-3 years, implants show a similar mobility as natural teeth supporting comparable denture constructions. The Periotest readings of implants were significantly lower than those of natural teeth, largely independent of the date of mobility measurement. A prognosis of functional properties as well as predicting the impending loss of osseointegrated implants is possible with the aid of long-term mobility measurements.

[Factors involved in endosseous implant function]. / Faktorenerfassung zur Funktion enossaler Implantate.

Periodontometric and Periotest mobility parameters of 87 endosseous implants were studied during a period of up to 6 years. Moreover, the condition of the surrounding bone and mucosa was assessed by means of the Periodontal Index (PI). Mobility of endosseous implants was lowest during the first year of insertion and highest at the end of the study. Among all those variables that had a favorable effect on implant function, the length of the implants was in the first line. What is called the osseointegration of dental implants is no longer evident after just a short period of masticatory loading by a denture. Mobility parameters of implants then increase to those of periodontally healthy natural teeth. Improved dental hygiene and cleansing of the periimplant area reduce the incidence of pathological findings and improve the prognosis of dental implants.

[Quantitative studies on the retention mechanism of complete dentures. I. Studies on a phantom model]. / Quantitative Untersuchungen über die Haltemechanismen der Totalprothese. I. Untersuchungen am Phantommodell

In four full maxillary dentures, the physical mechanisms of retention were examined and quantitatively determined by inductive pressure and motion recorders, in tests performed on a model and on the patients. In addition to capillary or viscous forces, the pressure difference existing in the space between denture and palate on the one hand and the oral environment on the other and resulting during pull-off, provides the greatest retaining effect.

[Epidemiological study on hepatitis morbidity in dental personnel on the model of the Erlangen university dental clinic]. / Epidemiologische Studie zur Hepatitismorbidität des zahnärztlichen Personals am Modell der Erlanger Universitäts-Kieferklinik.

1. The dentist and staff are exposed to nearly double the risk of hepatitis than the population in general. The risk of infection rises with proved contact with hepatitis patients. 2. About 60% of dental personnel suffers subclinical infections. A subclinically infected person is a source of infection for his patients. 3. The chief source of infection is blood contact. In comparisons with the practitioner with mixed dental practice, the surgically active dentist is exposed to three or four times the infection risk. 4. Serological determination of hepatitis antibodies makes it possible to demonstrate subclinical infections. 5. Consistent prophylaxis against infection is required. After proved contact with a hepatitis patient, infection can be prevented by timely treatment with hyperimmune serum.

Salivary secretion and denture retention.

Correlations between the retention of complete dentures and flow rates of the palatal and parotid glands were studied in 86 patients. The determination of secretion rates and forces of the forward leverage leading to a dislocation of the dentures showed a narrow correlation between the secretion of palatal glands and the retention of maxillary dentures. The retention of mandibular complete dentures is adversely influenced by the secretion rate of minor salivary glands. However, there is no correlation between the flow rate of parotid saliva and the retention of either denture. In addition, the medicinal stimulation of salivation showed that an increase of mucus secretion induced an improved retention of maxillary complete dentures.

[Psychopathological and psychopathometric findings in patients with dental prosthesis intolerance]. / Psychopathologische und psychopathometrische Befunde bei Patienten mit Prothesenunverträglichkeitserscheinungen.

It is discussed whether psychological factors can be accounted responsible for the intolerance to the wearing of prostheses which can not be explained on dental grounds. Psychopathological, psychometric and psychopathometric investigations brought the following results: 1. Patients with complaints differ significantly from a control group in the variables changeable according to situation: "general somatic discomforts", disturbances of vegetative functions, and "depressive moods". This points to a constitutional predisposition to vegetative irritability and lowered threshold to frustration. 2. Less intelligent persons are less able and prepared to incorporate and accept the prosthesis. 3. Among the personality variables differences in the attributes "uncontrollability and social responsiveness" show up in sample tests. The subjects consider themselves more esteemed, popular and acknowledged. 4. In the majority of subjects the making of the tooth replacement coincided with stressful events.

Immunohistochemical study of palatal salivary glands of denture wearing patients.

The binding pattern of antibodies against different cytokeratin (CK) polypeptides, tissue polypeptide antigen (TPA), carcinoembryonic antigen (CEA), lactoferrin (Lf), lysozyme (Ly) and secretory component (SC) in palatal glands (PSG) of long-term denture wearing patients has been studied to investigate immunohistochemically the localization of these marker proteins in normal PSG and in denture-induced sialadenitis of PSG. The study included palatal gland biopsies from 28 patients (15 f, 13 m; mean age 59 years), 17 of them with normal PSGs, 8 with focal obstructive sialadenitis, and 3 with diffuse sialadenitis. Presence of CK and TPA was found in all intra- and extraglandular salivary ducts, in the basophilic portions of acini, in some mucous acini, and in all atrophic acini. Increased expression of CEA and Lf was observed in inflammed areas of PSG which, on the other site, were devoid of Ly and SC. In the mucous acini of healthy PSG considerable basal Ly immunoreactivity was seen. SC was localized in almost all ductal cells and in some acinar cells. Appearance of Lf in the ductal cells of PSG indicates an early sign of palatal sialadenitis. Some distinctions in the expression pattern of the marker proteins between the mucous acini of major salivary glands and PSG point to differences in the functional activities of either group of salivary glands.

[Quantitative comparison of the secretion of salivary and mucous glands]. / Die Sekretion der Speichel- und Schleimdrüsen im quantitativen Vergleich.

The flow rates and the Na+/K+ quotients of the saliva from the parotid and palatine glands were determined by direct comparison in 121 patients. The results showed that the flow rates and the Na+/K+ quotients of the same types of glands were not correlated with each other. Pronounced and specific interrelations as to the amount of secretion were observed only in patients complaining about dry mouth or smarting of the mucosa or patients under chronic treatment with psychoactive drugs where secretory inhibition is a side effect. The evaluation of the Na+/K+ quotients demonstrated that the secretion examined was almost exclusively resting saliva secretion. Based on these observations it is important that our understanding of the control mechanisms governing the activities of the different gland types within the masticatory system be reassessed.